ST. PAUL - Minnesotans either will get a better deal on health insurance or they will face problems if the Legislature and governor agree on a new way for 1.3 million Minnesotans to buy health insurance.

That is how the debate boils down about a bill the Democrat-controlled House Monday night approved 72-58 over Republican protests. Rep. Jim Abeler of Anoka was the only Republican to vote for the plan, an attempt to be involved in a House-Senate conference committee that will craft the final bill.

“Whether you are on one side of the aisle or the other, there is no question it really is the most significant health insurance reform we have seen in 50 years,” Rep. Joe Atkins, DFL-Inver Grove Heights, said to open five and a half hours of debate.

Republicans, who put up nearly 100 amendments to change or gut the bill, agreed it was significant, but said the measure was not ready.

“I have never seen a bill that does so much, but is understood so little by members of this chamber,” Rep. Matt Dean, R-Dellwood, said.

Senators take up a similar measure Thursday. Democratic Gov. Mark Dayton is expected to receive a final bill by the end of the month, signing it into law to put the exchange in place in time for Minnesotans to begin shopping for insurance on line by fall.

The exchange is in response to a federal health care law known as Obamacare.

“In one way or another, we are going to have a health insurance exchange,” Atkins said, because if the Legislature and Dayton do nothing federal officials will set up the system.

If the exchange becomes law, Minnesota would become the only state in the area to adopt the concept. Wisconsin, North Dakota, South Dakota and Iowa are not on track to set up exchanges, so the federal government will run exchanges there.

Rep. Debra Kiel, R-Crookston, said the law will cost the state. She told of a northwestern Minnesota chiropractor who said that if the bill becomes law he would move to North Dakota, where there are fewer restrictions.

“They have looked for 12 years to employ chiropractors in their business and have not been able to,” she said, because most have opted to work in North Dakota.

Rep. Dan Fabian, R-Roseau, said the exchange bill is being rushed through the Legislature.

The exchange would lump northwestern Minnesota counties, where insurance rates are relatively low, with the Twin Cities, Fabian said, which could bring higher premiums to his area.

Atkins said the average Minnesota family should save $490 a year with the exchange, and some estimates say costs could drop up to $1,800. He said 70 percent of Minnesota families would pay less or the same as they do now when they shop on the exchange.

The exchange would be available through the Internet and by telephone. It is supposed to make it easy to compare insurance policies and their prices.

Atkins said 1.3 million Minnesotans would buy insurance through the exchange. Of those, 300,000 lack insurance today.

Federal law requires every American to carry insurance or pay a penalty.

Insurance policies on the exchange would “be far better than health insurance than they can purchase today,” Atkins said. “Moreover, it will be at a better price.”

One change in the bill came when Rep. Patti Fritz, DFL-Faribault, succeeded on a 71-58 vote to amend it to forbid policies bought under the exchange to fund abortions. Federal law also outlaws that.

A few relatively minor Republican amendments did go on the bill, such as one allowing Minnesotans to keep the doctor of their choice. However, most GOP amendments failed, with the bill looking much like it did before the full House debate began.

The bill went through nine committees in the past few weeks as it took 47 hours of committee debate.

Rep. Tom Anzelc, DFL-Balsam Township, said northern Minnesotans do not want a one-size-fits-all exchange like would be offered by the federal government.

“Individuals, families, and businesses in northern Minnesota have been squeezed by rising health care costs for far too long,” Anzelc said. “Thankfully, we’re on track to set up an exchange that provides relief by offering tax credits and increasing competition.”

Rep. John Persell, DFL-Bemidji, said the bill is good for the state.

“Families need medical insurance,” Persell said. “And when they aren’t covered, the cost for their medical care and emergency room visits falls on the taxpayers. This helps reduce those costs by helping Minnesotans get preventative care that will drive overall health care costs down.”

Rep. Roger Erickson, DFL-Baudette, said the exchange will help Minnesotans find affordable insurance.

“But right now, thousands of families have a very tough time finding plans that are affordable,” Erickson said. “This exchange will act as a kind of one stop shop for finding which plans work for you.”

Rep. Mary Sawatzky, DFL-Willmar, called the bill a positive step.

“Regardless of your feelings on the Affordable Care Act, when it comes to the health insurance exchange, I think we can all agree that we would rather have it be a Minnesota-made exchange, rather than a one-size-fits-all federal model,” Sawatzky said. “Minnesota is already known as a health care leader and by taking charge of our own exchange, we can maintain that reputation.”

Rep. Ben Lien, DFL-Moorhead, said the state would maintain control with an exchange.

“A state exchange allows us to control the products, services and systems so that Minnesotans are best served,” Lien said. “Minnesota is uniquely positioned to be a national leader on health care exchanges and our early action on the health insurance exchange is expected to save Minnesota taxpayers billions of dollars. This legislation will make health care more affordable and accessible to the people of Moorhead."

Don Davis has been the Forum Communications Minnesota Capitol Bureau chief since 2001, covering state government and politics for two dozen newspapers in the state. Don also blogs at Capital Chatter on Areavoices.